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Home My WebLink About3277-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE BF BBBUPANBY No. ~ .1281.0 Date ..... &U~..3.7 ., 196~' THIS CERTIFIES that the building located at N/~I ~ ~Ve Street l~assau Map ~N0. Block No. Lot No. 2~2~,e1~... ~'uteho~,ae,. R,¥,.. conforms substantially to the Application for Building Permit heretofore filed in this office dated 0et -. 3 , 19 g(;. pursuant to which Building Permit No. 3~F~ Z dated (~C~; 1~' ., 19 66 , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is l?F~,~t;e O~8.1'al~,:kl,y..clwel~tl~g .................................... The certificate is issued to ~l~'~e.~, .& l'~'&a. Ir~on .......... OVlte~g ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~[~. 2~ 1,~'~.. ~:~y.l~,,..'~'l].]la ..... ........... ~lding Inspecto~ FO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, hi. Y. ~i~ BUILDING FERMIT ~ tO'HIS PERMIT MUST BE, KEPT ON THE PREMISES U~'4TIL FULL, "Jil COMPLETION OF THE WORK AUTHORIZED) /'N°/ · ', ~ ,~.~,~ ?? 3277 Z D~e ...................... ~ ................ .~ ....... , Pe~iss'i~n is hereby granted to: - - ' ................... ~9~.....~sm~..s~ .......................... premises [occrted ...... .......... :Z~.-_ =~..~, ..................... : ............................... ' .......... Gt ~ ......... :~/~-...~..~ ........... ~'~t~m,..!l,,X, ......... ~ ............................ pursu~, to pppliFationdated ....................,.....0,~.~...;, ..... '~ ~"'"~., 19..~.~ ~ ,nd approv~ by th~" Fee $~}.~ ............. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Agl) ;~ 19~ Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. District Engineer District Engineer SUFFOLK COUNTY DEPARTMENT OF HEALTH E~STERN DISTRICT, R'i~9,~.Y. H.D.Reference No 5 d APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ~ / f..¢'~ ~ ~/~ ~, ~] Phone 6-Sub div Address ~' ~ £~ ~ o ~ ~ ~- , ~'~ \ ~ 7-Section 2-Detailed property l~cation · / j ~/~*~a~ ~ ~' F j~ S-Lot No. , ~ r~ ~,~. ~ ~ ~ ~ ~- .~ 9-Private well? 3-Public water supply name Distance to nearest main / ": ~ ~-Lot size: Length ,~,'Oft. ~,idth /'~ft. (Also enter o~n center plot plan below:) 5-Dwelling: Single'.~ly?/_ ~,/~wo fam1 ly?/__/.Cellar?/ "/Slab?/ /Crawl Space?/ / lO-Proposed system. Septic tan~/ /Precast/ ~/Cesspools~Sh~-~ls/ /other/ / il-Septic tank inside dimensions:Volume Gals.Length Ft.Width ft. Liquid depth ft. 12-Precast sections:/ J/Number./~' ./Square ft.Cesspools:Block siz~L- ins.D ins.H ins. PLOT PLAN Data Feet! 2 8 ,..~4,, x': 16 18 The Undersigned CERTIFY: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards,Bulletins, and amendments thereto,covering Private Sewage Disposal Owne'r or Bu:[lder ' FC~ HEALTH DEPARTMENT USE ONLY. Based on the tn*ormation presented herewith,it is the opinion of the Health Department,that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date ~ '''/ ~;' .,P Signed ~. ~' ~- -~ ) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned .......... ~....../..Z.., 19..~....~ Approved ........................................ 19 ........ Permit No ............................ D~sapproved a/c APPLICATION FOR BUILDING PERMIT Date .Ol~nbsat...~,..1.9~ ....................... , 19 .......... INSTRUCTIONS a This apphcat~on must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin. Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets c areas, and gwmg a detailed description of layout of propertymust be drown on the d,agram which is part of this applicatior c. The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of thru application, the Building Inspector will msue o Building Permit to the applicant. Suc permit shall be kept on the premises available for mspectmn throughout the progress of the work. e No build~ng shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bu.ldmg Department for the issuance of o Braiding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe- The applmant agrees to comply with all apphcoble lows, ordinances, building code and regulations. ........ ........................................ (~i~nature of applicant, or name, if a corporation) Eew Yox'k ........................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or builde. Ownez. ................................................................................................................................................. Name of owner of premises .../~.~..~....~'.m...f~.~...~:[~.~..~ ....................................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on wh,ch proposed work will be done. Map NoNl~l*.~.[~,..~.9~..~..,*...g..u..t'..o...h. Pr~qqo:~a.....~:......&.'.. Street and Number ..B...lt~....A..~...e..~...~.9.t...g..~..~....e~..9/~.~...o.~....~..~..~9.~. ........................................................................ Mumcipality 2. State exmting use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................ b. Intended use and occupancy . ~0 3 Nature of work (check which applicable). New Building .................. Addition ...~ ........... Alteration '"X' .......... Repair .................... Removal .................... Demohtion .................... Other Work (Describe) ~Lc~c&e,,O...O~, ......... 4. Est,mated Cost ..~.(~l~ ........................................... Fee ...~J~;tl..,l~k],f~.~! ...................... ?....Z~....~..O.~.~.~.,. .............. (to be paid on filing th~s application) 5 If dwelhng, number of dwelling units ....0...~.?. .................. Number of dwelling units on each floor .......................... If garage, number of cars ......................................................................................................................................... 6. If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use .............................. 7 D~mens~ons of existing structures, if any: Front ~CJ.!.~].!. ........... Rear ..~.~.t. fo.!..I. .......... Depth .c..,~.t.'~.l..! ........... Height ...... 'j.~l. ................ Number of Stories .... 01~,e .................................................................................................. D~mens~ons of same structure w~th alterations or additions: Front ...~.~t.(~.L.l. .............. Rear ..~,.9.~.L! ............. Depth .~.~.?.~?..?. .............. Height ......'1.;~.? .................. Number of Stories ..... DZ~i~. ........................... 8 D~mens~ons of entire new construction: Front .... ~,cj.!.C~.t..!. ......... Rear ....,~.~.t.~.(~ .......... Depth ...,~.!.~.1...I. ........ Hmght ....1.~,.t. .................. Number of Stories ....... 0~ .............. 9 S~ze of lot Front ~...O~.......I~....e.~ ........ Rear ]..3.~....~.e..l[;. ....... Depth ....~.~.~....A~...O..~ ......... 10 Date of Purchase .~.~..~..q~...~.¢.~....Jj~...~..~.~ ............ Name of Former Owner .~.,.4~.,...~/,,t,.o.~f~ ........................ 11. Zone or use distnct m which premises are situated ............................................................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulahon? ..... ~ .......................................... 13 Name of Owner of premises ..A~..~.e.~....~.~..~. ...... Address~.~'...~r~l'.~,~...~..t,..:~...O...~.~.. Phone No.T~..~.-.~ Name of Architect ...................................................... Address~.O....J~.....~..~....t!..e..~.....~..O..~.. Phone No ................... Nome of Contractor ...~..b.~r~...~l,¢,~ ............... Address ...g.~t~e,.,J:tg~...I~'.~l~'., ...... Phone No. PLOT DIAGRAM Locate clearly and dmtmctly all buildings, whether existing or proposed, and ~ndicate all set-back dimensions fro~ property hnes. Give street and block numbers or description according to deed, and show street names and mdicat whether inter,or or corner Jot. STATE OF NEvy_.?.ORK, . ~ c c ~) (~ '~ J~ ..... ~ ~" · ~~of ind,vidu~ s,~,n~ opphcotion) .............. be,no duly sworn, deposes *nd s~ys that he is the opplicor above named. He is the ......... ~~ ................................................................................................................ of-~i4 ~Wn~,'s, and is duly authorized to perform or have performed the said work and to make and fml this appiicatian, that all statements contained m this application are true to the best of his knowledge and belme and that the work w~ll be performed in the manner set farth m the application filed therewith. Sworn ~ me this~~ ~ / ..... ~ .............. dayof.~ ............................... , 19~ /~ *~ ~ / ~ ~ ....... LL:;'; ..... ........................... NOTARY PUB'.':, StoJe of N~ ~o~ ~